Anthony, Dorothy 1W) '
NEW YORK STATE DEPARTMENT OF HEALTH f . t*Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
k, Dorothy Eleanor Anthony Female
Date of Death Age If Veteran of U.S. Armed Forces,
12/16/2018 88 Years War or Dates
j Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death®Natural Cause ❑Accident Homicide El Suicide El Undetermined Ei Pending
Circumstances Investigation
tu Medical Certifier Name Title
O Rodney Ying MD
I Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
5 City, Town or Village Saratoga Springs 4501 662
El Burial Date Cemetery or Crematory
12/18/2018 Pine View Cremation
❑Entombment
Address
®Cremation Queensbury Town, New York
Date Place Removed
Z rl Removal and/or Held
tg and/oriii
Address
Hold
Date Point of
044 El Transportation Shipment
O by Common Destination
Carrier
Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
_' Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Stpo Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
Criu
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/18/2018 Registrar of Vital Statistics John FrznckeETctronicaufySigne
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Iii Date of Disposition r }/t ci/16- Place of Disposition P;r e V a t w ce r�'�Or a+#1'^
M (address)
0
(section) 4lot number) (grave number)
Q Name of Sexton or Person in Charge of Premises �'�L4c I '` t��f
(please print)
Signature i� / Title Cret,c.}n.,-
(over)
DOH-1555 (02/2004)